“It is the first time since 2017 that a famine has been declared anywhere on Earth,” I read earlier this year. The famine in question was in Sudan. Soon after, I read another headline: “Famine confirmed for first time in Gaza.”
As images of emaciated children spread across social media, the question loomed over Western onlookers: What can we do for starving kids halfway around the world?
This story is part of the 2025 Future Perfect 25
Every year, the Future Perfect team curates the undersung activists, organizers, and thinkers who are making the world a better place. This year’s honorees are all keeping progress on global health and development alive. Read more about the project here.
Many tried applying political pressure through advocacy, of course — but that didn’t work fast enough to prevent famine this year. There’s always donating to charity — but a lack of money is not the main driving force behind today’s famines. In the 21st century, famine is a policy choice. It largely happens because of conflict. It happens because fighting makes it too dangerous to get food to those who need it, or because the people in power block lifesaving aid from flowing across their borders.
That poses a moral problem for the average person: You see kids starving. You see the ways in which you seem powerless to prevent their starvation even after you’ve done whatever you can politically or financially. And yet, you somehow must act ethically in the face of that. How?
Inside this story
• Famine has come roaring back this year, but the good news is that simple innovations are making it surprisingly cheap to fight hunger.
• For $94, you can get a malnourished child access to a highly effective treatment program. For $1,500–$4,500, you can save a child’s life.
• Organizations like Taimaka, Alliance for International Medical Action (ALIMA), and the International Rescue Committee (IRC) are great places to donate.
In the spring, while reading a report about highly effective charities, I stumbled upon a nonprofit called Taimaka, which works on treating acute malnutrition in Nigeria. That country is not in the midst of famine, which is only declared when more than 30 percent of the population in an area is acutely malnourished, and when a specific mortality threshold is met. But in Nigeria, like in other countries across sub-Saharan Africa, there’s still a lot of hunger.
I went to Tamaika’s website and saw that it made an extraordinary claim: For just $94, I could get a severely malnourished kid access to its treatment program, which has been shown to help the vast majority of kids recover within weeks. That’s less than my partner and I had just spent on a single dinner from Uber Eats.
But what really shocked me was the cost of actually saving a life with Tamaika’s program, which is a little different. Since not every person who gets treated for malnutrition would have died otherwise, you’ve got to treat a bunch of people before you can assume you’ve actually saved one person’s life. In my reporting on effective philanthropy, I was used to seeing programs — particularly malaria programs, which are among the most cost-effective — that said they could save a life for around $4,000. But Taimaka was claiming that with their hunger program, they could do it for just $1,500.
If that’s true, it would make this one of the cheapest ways to save somebody’s life. I wondered: Could I really prevent a kid from dying that easily? And if so, why wasn’t everyone doing it?
How simple innovations made it cheap to fight hunger
Even though the world produces more than enough food to feed everyone, acute malnutrition remains the leading cause of childhood deaths globally, killing around 2 million children every year. But the good news is that it’s extremely treatable. The main route to recovery is a little pouch of something known as RUTF (ready-to-use therapeutic food) — a vitamin-rich, peanut-based paste that can cure kids from being dangerously underweight in weeks. RUTF’s high nutritional value allows kids to gain weight more quickly than regular food, plus it’s easily digestible.
Unfortunately, those pouches of food are expensive, and so is classic clinical treatment, which includes care at the hands of doctors and nurses. For example, in Nigeria, where Taimaka operates, that treatment has traditionally cost $251 per child — a lot of money in sub-Saharan Africa. The result is that more than 75 percent of malnourished kids go untreated.
So Tamaika, along with a couple of other innovative organizations like the Alliance for International Medical Action (ALIMA) and the International Rescue Committee (IRC), are focused on tackling a big question: How can we bring that cost down so we can save more lives?
“What we do differently is that we really have an eye towards, how can you do this as efficiently as possible?” Taimaka co-founder Justin Graham told me. “We had a cost-effectiveness model before we ever had a program.”
Together with cofounder Abubakar Umar, a doctor with years of experience working in the hospital system in Nigeria, Graham decided to apply three innovations. The first is to rely mainly on community health workers, as opposed to doctors or nurses in hospitals. Community health workers have less specialized training, but that means they’re cheaper, and families don’t have to travel impossibly long distances to a hospital to access care.
The community-based care model has been growing increasingly popular in developing countries. It’s used in the mental health context, too: Highly effective charities like StrongMinds and Friendship Bench get lightly trained laypeople — picture someone like your grandmother, not your psychiatrist — to deliver brief therapy sessions in a home or a park. It’s also used to expand access to everything from family planning to HIV services. Empowering non-specialist providers or laypeople to take on tasks formerly done by specialists is what the World Health Organization refers to as “task-shifting” or “task-sharing.”
The beauty of task-shifting is that it allows a program to scale up quickly and cheaply, while still delivering quality care. When workers encounter a complicated case that’s beyond their capacity, they refer the case to a nurse or doctor for care. When they can handle cases themselves, it frees up scarce expert health resources.
Taimaka adopted this innovation — and then digitized it. The organization realized that when health workers record everything on paper, as is still common in sub-Saharan Africa, it’s highly time-intensive for staff. Plus, it doesn’t efficiently get feedback to higher management, so you end up needing more skilled managerial staff on the ground in each facility, which drives up costs. By providing health workers with a digital tool that helps them triage kids and record all the necessary data, Taimaka ensures quality of care at a lower cost — and quality of data that can then be used to inform research on the program.
Finally, Taimaka reduced how much money it spends on therapeutic food by using recent evidence from a randomized controlled trial (RCT) — the gold standard of medical evidence — run by ALIMA. That research found that children recover just as well if you taper their dose of therapeutic food over time; previously, the protocol had been to increase it over time in proportion to the child’s increasing weight, which the new research found is not necessary.
“We looked around and saw, wow, there’s an RCT on this, and the WHO doesn’t want to move on it yet,” Graham told me, adding that that organization is slower to revise its protocols. “We were missing out on kids getting treated in the meantime. And so we asked, what is the bleeding-edge evidence that we can take and incorporate into our program, so we can validate it quickly and show that it works?”
Turns out, it works beautifully. A whopping 95 percent of the children in Taimaka’s program fully recover. And by saving money on personnel and food, the program can afford to treat more kids in need. That is what allowed Taimaka to estimate that it could save a life for just $1,500.
Not everyone is so sure about that estimate, however, because of the quality of the evidence base. GiveWell, a nonprofit that evaluates and recommends the charities that save or improve lives the most per dollar, has some questions.
“Certainty is one of the criteria that we use for deciding on top charities,” Alice Redfern, GiveWell’s program officer specializing in nutrition, told me. And when evaluating a malnutrition program, it’s just really hard to gather the kind of causal data that would provide certainty about how many lives the program is saving that wouldn’t have been saved otherwise. You can’t show up to a malnourished population and say, “We’re going to treat half your children and let the other half starve, so that we can gather really good causal data on the treatment effects of our program.” That would obviously be unethical.
Other questions dog malnutrition programs, too. For example: When a program treats children and then sends them home cured, what percentage of those children end up needing treatment again later that year? Taimaka thinks it’s only 5-7 percent. (Even if an area suffers from chronic food insecurity, kids there won’t always progress to severe malnutrition; oftentimes, a child will only go from mild to severe malnutrition if they contract an infectious disease that worsens their condition.) But GiveWell suspects the relapse rate may be higher. That leads GiveWell to think it’s too optimistic to suppose the program is really saving a life for $1,500. So Taimaka has revised its estimate; its website now says it can save a life for $1,500-$4,500, indicating that some uncertainty remains.
But that doesn’t mean Taimaka isn’t effective. “Even with that, we still think it’s a pretty good bet,” Redfern said. Other charity evaluators agree. Although GiveWell does not yet rank Taimaka among its top charities, it was impressed enough to give Taimaka a grant last year to expand its programming. (Graham says that in five years, he hopes to be treating more than 100,000 patients annually.) One of the reasons GiveWell is excited to partner with the program is that they believe that, together, they can learn a lot about how to treat hunger cost-effectively, and use those learnings elsewhere.
“Taimaka is really laser-focused on trying to treat as many children with as few resources as possible and maintaining really high-quality programming at the same time,” Redfern said. “And I think that also because of that, they’re very focused on learning and iterating.”
“The most neglected child is the malnourished child who’s not living in a CNN emergency”
Picture two types of funding with different purposes: humanitarian aid and development aid. Humanitarian aid responds to acute emergencies — like wars that precipitate famine — providing immediate, life-saving help. Development aid supports efforts to reduce poverty and build resilience in low-income countries that face chronic challenges like food insecurity.
Hunger can stalk children in both scenarios. And if you’re a kid suffering from acute malnutrition, it doesn’t matter to you whether you’re in a humanitarian context or a development context. You’re just hungry. You just need help.
Unfortunately, malnourished kids in the development context too often go ignored.
“The most neglected child is the malnourished child who’s not living in a CNN emergency,” Susan Shepherd, a pediatrician with ALIMA, told me.
And when it comes to development aid, Graham said, “what really appeals to people oftentimes is preventative things.” Funders are often excited to fund a vaccine program that prevents a disease, say, because it’s a one-and-done fix that averts the need for later treatment. As the old saying goes, an ounce of prevention is worth a pound of cure.
But this preference for prevention over treatment can mean that malnutrition gets sidelined, because malnutrition is not straightforward to prevent. That’s because it’s not one problem, like a disease caused by a single virus — it’s a devilish set of interrelated problems. For one thing, it exists in a bidirectional relationship with infectious disease: poor nutrition can make people more vulnerable to disease, and vice versa.
Imagine a kid who’s food insecure. He’s not getting proper nutrients, so he has a weaker immune system. One day, he gets diarrhea from unclean drinking water. Now that he’s sick, it’s much harder for his body to retain nutrients. He gets weaker, to the point that he can’t recover without help. But he’s unable to access treatment — either it’s too expensive, or the facility is too far away, or the road infrastructure is lacking, or there’s a security problem…
“Until you solve all of these problems, malnutrition will keep happening,” Graham said. “And solving all these problems means making Africa a developed continent. That’s a 10, 20, 30-year target, if not longer.”
Meanwhile, one kid dies of acute malnutrition every 15 seconds.
“So, are we going to let millions of children die in the next 10 years, before we solve this problem?” Graham continued. “That is unacceptable to me.”
Dr. Joseph-Désiré Yuma Ilale, who works for ALIMA from Abuja, Nigeria, agrees. He emphasized that if we neglect to treat malnourished kids, we’re damning their future and their country’s future, because those who survive still suffer from setbacks to their neurodevelopment.
“It has been shown that the cognitive development of children who are undergoing several episodes of malnutrition might not be the same as other children who are not having malnutrition,” he said. That, in turn, could lower their academic performance and lifelong earning potential. So, he suggested, we could consider malnutrition treatment itself a kind of prevention.
“Investing in community-based management of malnutrition is not really a charity,” Yuma Ilale told me. “It’s an important investment in life.”
Of course, treating malnourished children in a country like Nigeria is no replacement for treating children in famine-stricken humanitarian contexts. Every child is irreplaceably precious. Every life lost is a tragedy. And there are so many lives that we have not been able to save this year.
At the same time, there are many children in the world we definitely can help right now, and yet are neglecting to help because we don’t realize that there is still so much more we can do. These are the children living outside the headlines, living through the quiet emergencies, whom we can save with astonishing ease.
